TRENTON - An effort by New Jersey lawmakers to require the fluoridation of public drinking water throughout the state has run into a formidable foe: the troubled economy.

A bill to mandate fluoride in community drinking water cleared the Senate health committee last week, but the chairwoman of the Assembly Appropriations Committee, Nellie Pou (D., Passaic), does not plan to post the bill for a hearing, which could kill the effort.

Tom Hester Jr., a spokesman in the Assembly Majority Office, said Pou was concerned about the "potential cost to the consumer."

The bill would require public and private utility authorities to add fluoride to drinking water unless natural levels of fluoride already met guidelines. The companies would be permitted to pass the additional costs on to consumers.

Public health experts say the evidence in favor of fluoridating drinking water, to help prevent cavities, is overwhelming.

The Centers for Disease Control and Prevention, for example, has called community water fluoridation one of the 10 great public health achievements of the 20th century.

"It does so much for the dental health of all of our citizens, particularly those who live in communities of lower income, who don't have access to regular dental care," said Sen. Joseph Vitale (D., Middlesex), a sponsor of the legislation.

New Jersey lags far behind the rest of the country in fluoridation. Only 22.5 percent of New Jersey residents on public water systems receive fluoride in their water, compared with about 70 percent nationwide, ranking the state ahead of only Hawaii. In Pennsylvania, about 54 percent of residents drink fluoridated tap water.

Forty-five of the 50 largest cities in America have fluoride in their tap water, including Philadelphia, which has had it since 1954, but many cities in New Jersey, including Camden, do not.

Advocates say fluoridation is both inexpensive and effective at preventing tooth decay, especially among children, but also for adults.

The American Dental Association has cited studies showing that people who drink fluoridated water from birth have 35 percent less tooth decay during their lifetimes.

But opponents to adding fluoride to drinking water offer a range of arguments, including possible side effects and potential impacts on the environment.

Sen. Gerald Cardinale (R., Bergen), a dentist, said fluoride's benefits were well-documented. He opposes the bill, however, because he believes people should not be forced to consume it.

"The problem that I have with the bill is I have a philosophical bent against forcing people to be medicated," Cardinale said. "While I believe it would serve a very useful purpose in terms of limiting cavities, it also limits people's freedom."

Assemblyman Jeff Van Drew (D., Cumberland), also a dentist, said that, while he understood the importance and benefits of fluoride - and has given it to his own children because he lives in a region with well water - the state's finances were his priority right now.

Van Drew said that now was not the time to embark upon a new program regardless of its worthiness.

Some have argued that communities should be allowed to determine for themselves whether to fluoridate their water, although New Jersey's numerous municipalities make that more difficult than in most other states.

Some environmentalists also oppose the fluoridation of water. Jeff Tittel, director of the state chapter of the Sierra Club, said the proposed bill would allow water suppliers to use a fluoride that was derived from a by-product of fertilizer production. Tittel said toxic chemicals such as lead, arsenic, and cadmium could sometimes be found in such fluoride.

"Instead of taking toxics out of our drinking water," Tittel said, "we'll be adding them."

But advocates counter that the benefits of fluoride far outweigh the costs and that the effects of fluoride have been exhaustively studied and investigated.

Assemblyman Herb Conaway Jr. (D., Burlington), a practicing physician and another sponsor of the bill, said more than 50 years of experience with fluoridating water has proved it safe. More than 180 million Americans drink fluoridated water, along with residents of more than 50 other countries, Conaway said.

He said more than 260 studies have shown fluoride in drinking water to be safe.

At a hearing Dec. 7 before the Senate Health and Human Services Committee, Karen Alexander, president and chief executive officer of the New Jersey Utilities Association, testified that the legislation would "result in increased costs to ratepayers at a time that they can least afford it." She said it would cost her members from $400,000 to more than $64,000,000 to add fluoride to tap water.

Those costs, she said, would be borne by any of the 4,136 public water systems in New Jersey that are not already adding fluoride to water.

She also said the 12-month implementation schedule called for by the bill was "unworkable," saying it would take from two to four years to install the infrastructure to add fluoride to water.

Conaway said those cost estimates were 100 to 1,000 times more than what he had heard from other jurisdictions.

According to the state's nonpartisan Office of Legislative Services, once the infrastructure is in place, it costs between 25 cents and $1 per person per year to add fluoride.

The CDC estimates that every $1 spent in fluoridating drinking water saves $38 in dental costs down the road - costs that are borne in part, Conaway said, by taxpayers.

Conaway and Vitale said they were working to try to persuade Pou to hold a hearing on the bill.

Contact staff writer Adrienne Lu at 609-989-8990 or alu@phillynews.com.